32 - Are inpatient providers getting SMART about asthma?

Poster Number: 32
Publication Number: 32.300

Katherine Pumphrey, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Jessica hart, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Chen C. Kenyon, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States; Michelle Dunn, Childrens Hospital of Philadelphia, Philadelphia, PA, United States

Background: Approximately 8% of US children have a diagnosis of asthma with 1 in 20 children with asthma requiring hospitalization yearly. In 2020, the National Heart Lung and Blood Institute (NHLBI) released the “2020 Focused Updates to the Asthma Management Guidelines: A Report from the National Asthma Education and Prevention Program Coordinating Committee Expert Panel Working Group” that included the recommendation for Single Maintenance and Reliever Therapy (SMART). SMART includes daily and as needed inhaled corticosteroid (ICS)-formoterol combination.

Objective: Following a series of lectures of the 2020 asthma management guidelines, we sought to better understand how often SMART was initiated for potentially eligible children admitted for status asthmaticus and potential barriers to initiation.

Design/Methods: As the initial steps in a quality improvement (QI) process, we conducted a retrospective chart review for children with frequent asthma hospitalization (³2/year) from 12/2020-11/2021 at a large academic children’s hospital with over 2500 asthma hospitalizations/year. We defined SMART eligibility per the 2020 NHLBI recommendations: children aged 5 or older with poorly controlled asthma treated with at least a daily ICS and as needed SABA. We conducted a subsequent focus group of pediatric hospitalists to identify inpatient barriers to SMART initiation.

Results: 40 patients with 2 or more asthma hospitalizations/year were reviewed. 32 patients were potentially eligible for SMART. 2 (6%) patients were started on SMART. Pediatric hospitalists identified a lack of adequate knowledge and comfort with SMART, both personally and among team members that provide education for patients as a common barrier. Several hospitalists felt outpatient providers were either more appropriate prescribers of SMART or, alternatively, may not be comfortable with SMART if initiated inpatient. Other barriers included concerns regarding insurance coverage, stopping albuterol at discharge, and family discomfort.Conclusion(s): Our chart review of frequently hospitalized children with asthma indicated that only 6% of potentially eligible patients were transitioned to SMART. Pediatric hospitalists identified a lack of knowledge of and comfort with this paradigm shift in asthma management, as well as lack of alignment of inpatient and outpatient systems of chronic asthma management, as key barriers to initiation. These results highlight the need for further QI efforts to overcome barriers to SMART initiation and the need to improve SMART education and workflows so patients and providers may feel comfortable starting SMART inpatient.